The Bernard L. Pacella, MD Parent Child Center

Resources: Expert Opinion

Learning Disabilities

By Leon Hoffman, MD

Letter to the Editor, The Wall Street Journal, September 22, 1997

Dear Mr. Crabb,

As a child psychoanalyst and child psychiatrist, I was very troubled by John McGinnis's article, "Attention Deficit Disaster" (September 18, 1997).

Mr. McGinnis is certainly correct to deplore the over-diagnosis of ADD and the over-prescription of Ritalin in school-aged children. He believes that this problem is the result of teachers and counselors recommending an ADD diagnosis to parents of rambunctious youngsters in order to get troublesome children on Ritalin. His solution is the restoration of old-fashioned discipline to substitute for a "phony therapeutic approach." Both his diagnosis and solution are simplistic and ultimately self-defeating for our nation's children.

It is important to consider two facts of development. Firstly, children often express their emotions and feelings through action. Secondly, children with a variety of psychological and emotional stresses may have difficulties attending to required tasks. Thus, when a child has behavioral and/or attentional problems one cannot automatically assume that the child has an Attention Deficit Disorder. For example, an overactive child or a child who cannot concentrate may be anxious, depressed, or may be responding to familial or other stresses. It is critical for the mental health professional to make an accurate individualized assessment of the child's and family's situation in order to determine the best course of action. Children may need to talk to a trained child psychoanalyst or psychotherapist about their problems and parents may require psychological help in order to examine their contribution to the child's difficulties, to understand the impact of the child's symptoms on them, and to differentiate between punitive discipline and appropriate limit-setting for their children. Certainly a psychopharmacological approach may be indicated.

All parents, children, and professionals hope to find a treatment route for difficult problems, a "magic bullet," that is simple, quick, and uncomplicated. Unfortunately, real life is very complicated and nine times out of ten, children's difficulties are the result of knotty interactions among the children's biological constitution, their inner psychological adaptations, and their reactions to complex environmental situations. Mr. McGinnis's solution of restoring old-fashioned discipline is simplistic, punitive, and ultimately ineffective, as ineffective as a managed care company's approach which promotes "quick-fixes" (i.e., pills) in order to maximize their financial gains.

Our nation's children deserve comprehensive individualized non-punitive therapeutic approaches for their problems.

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